Thrombolysis in acute pulmonary embolism

Area of Science:

• Cardiology
• Pulmonology
• Emergency Medicine

Background:

• Acute pulmonary embolism (APE) is a significant cause of cardiovascular mortality, often linked to hemodynamic instability.
• Systemic thrombolysis is the recommended reperfusion therapy for high-risk APE, but national data on its efficacy and safety are limited.

Purpose of the Study:

• To evaluate the efficacy and safety of systemic thrombolysis with alteplase in patients with high-risk or intermediate-high risk acute pulmonary embolism.
• To assess the rates of severe bleeding and mortality in this patient population.

Main Methods:

• Retrospective analysis of a single-center case series.
• Inclusion of 13 high-risk and 4 intermediate-high risk APE patients treated with alteplase 100mg.

Main Results:

• The study included 17 patients (mean age 55, 76.4% female) with common risk factors including immobilization and contraceptive use.
• Clinical manifestations included dyspnea, hypoxia, hypotension, and tachycardia. Right ventricular dysfunction was observed in 82.35% of patients.
• Severe bleeding occurred in 17.6% of cases, with no deaths attributed to bleeding. Mortality from right ventricular failure was 47%.

Conclusions:

• Systemic thrombolysis in high-risk and intermediate-high risk APE patients is associated with a 17.6% severe bleeding rate.
• Despite bleeding risks, the high mortality rate (47%) due to right ventricular failure supports the use of thrombolysis in this critical patient group.